TN 11 (01-17)
DI 13005.032 Continuing Disability Review (CDR) and Subsequent Claims Filed During Personal Contact
A. Introduction to personal contact during a CDR with a subsequent claim
The field office (FO) is responsible for explaining the possible impact of a subsequent disability claim on current benefits. For example, the filing of a disabled widow(er) beneficiary (DWB) claim by a disabled individual should not raise a continuing disability issue on the disability claim.
A CDR issue could arise only if the medical evidence raised a question as to the severity of the impairment or an unresolved work and earnings issue surfaces during the subsequent claims development. When a Title II beneficiary files for Title XVI benefits, he or she may require a CDR to determine continuing disability on the Title II claim. In the reverse situation, a Title XVI recipient filing for Title II could also raise a continuing disability issue.
B. Policy for Title II and Title XVI subsequent claims
If a Title II disability claim is filed subsequent to a Title XVI disability case, or a Title XVI disability claim is filed subsequent to a Title II disability case, the FO or DDS (as appropriate) will generally adopt the existing allowance to the subsequent claim under the other title, see DI 11011.005 and DI 11055.065. An exception to an adoption of the existing allowance occurs when:
a different definition of disability applies (for example, the previous Title XVI case is a conversion case or the Title XVI case is a Section 1619 case),
the impairment’s severity was found to be continuing during a period in which the individual engaged in SGA, or
there is a reason to question the previous disability determination.
However, we must carefully apply collateral estoppel, when a CDR was conducted in a previously allowed claim. Deciding continuing disability (CD), involves consideration of different issues than those that are involved in deciding disability in an initial claim, see DI 13005.005. This can result in a finding of CD in a case that could be a denial, if the consideration issues were deciding an initial disability decision.
Therefore, the basis for the continuance must be determined before applying collateral estoppel in any case when there was a CDR in the previously adjudicated claim. Collateral estoppel will not apply (and the DDS must make a wholly independent determination) in any case, in which the most recent medical continuance in the previously adjudicated claim was on the basis of “EVIDENCE INSUFFICIENT to Determine Medical Improvement.” The basis for the continuance should be determined from the SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title XVI) or SSA-833 (Cessation or Continuance of Disability or Blindness Determination and Transmittal – Title II).
In some cases, however, the current claim will raise a CD issue. In these cases, the FO must explain the possibility of a CDR on the original claim and the provisions of collateral estoppel, see DI 27515.000 and DI 11011.005C. Do not complete the form SSA-454-BK (Continuing Disability Review Report) and follow the procedures in DI 13005.030. Use the form SSA-3368-BK (Disability Report –Adult) with the subsequent claim for both the new claim and the CDR case. Annotate on the form SSA-5002 (Report of Contact) the possibility of a CDR and explain the step of the CDR process to the disabled individual, see DI 13005.030. Process the subsequent claim following existing procedures. For FO electronic case procedures, see DI 81010.000.
Once we perform a CDR involving Section 1619 eligibility, we must carefully apply the disability evaluation criteria applicable to this unique population, see SI 02302.006. Carefully review any shifts in eligibility between the regular disability provisions and Section 1619, see SI 02302.010.
NOTE: For subsequent claims routing and jurisdiction procedure for the FO, see DI 11055.055B. For the DDS procedures involving the prior claim, see DI 20505.010.